Reduced-force closed trocar entry technique: analysis of trocar insertion force using a mechanical force gauge

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Patient Safety

Background:

• Trocar insertion is associated with significant patient morbidity, mortality, and healthcare costs.
• Standard trocar entry techniques can exert considerable force, potentially leading to injury.
• Minimizing insertion force is crucial for improving surgical safety and outcomes.

Purpose of the Study:

• To compare the insertion force of a novel reduced-force closed trocar entry technique against the standard closed trocar entry method.
• To quantify the difference in insertion force using a mechanical force gauge.
• To evaluate the safety and feasibility of the reduced-force technique.

Main Methods:

• A prospective trial involving 25 patients was conducted in an operating room setting.
• A mechanical force gauge, integrated into a sterile glove, measured trocar insertion forces.
• Two techniques were compared: standard closed trocar entry and a novel reduced-force closed trocar entry involving pre-dilation with a hemostat.

Main Results:

• The reduced-force trocar entry technique demonstrated a median insertion force of 3.3 lb, significantly lower than the standard technique's 6.5 lb (P=.001).
• The range of forces for the reduced-force technique was 1.6 to 5.4 lb, compared to 2.0 to 14.0 lb for the standard technique.
• No complications were reported with the reduced-force trocar entry technique during the study.

Conclusions:

• The reduced-force closed trocar entry technique effectively decreases trocar insertion force by approximately 50%.
• This technique requires no additional instruments or costs, is rapid, and is safe for patient use.
• Lowering trocar entry force pressure holds potential for reducing the incidence and severity of trocar insertion injuries.